For Obamacare, it’s finally showtime

In the new year, the Affordable Care Act still faces many obstacles. | AP Photo

Instead, they’re now saying that even a smaller number would be fine, as long as there are enough young and healthy people to keep the health plans financially stable.

And even though it’s not clear yet whether that’s happening, they’re convinced that it will happen by the end of March, because they expect a big wave of people to sign up at the last minute — mostly people who didn’t have any reason to enroll earlier.

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“We are focused on the long game for March 31,” said one White House official, because the experience of Massachusetts — which paved the way for Obamacare with its own health reform law in 2006 — “shows that people come in at the end.”

Back to the courts

This spring, there will be a bit of a Supreme Court flashback as the law goes back to the high court, this time on whether its contraceptive coverage requirement should be struck down or limited.

Sometime this spring, the justices will hear one hour of arguments on two challenges to the mandate, which requires most large employers to cover FDA-approved contraceptives at no cost to their workers. Then, the court will rule on whether private companies should should be forced to provide the coverage if the owners have religious objections to it. That’s a candidate, once again, for one of the final rulings of the Supreme Court session — meaning it would come out at the end of June.

But the mandate is already before the court in a more limited way. Sotomayor’s ruling Tuesday night blocked the requirement for a Denver home for the elderly that’s run by Catholic nuns. The government has to respond to the order by 10 a.m. Friday. It’s technically a narrow ruling, but any further action from the court could have a much broader reach.

The contraception requirement isn’t as central to the law as the individual mandate, the focus of the law’s previous trip to the high court, in 2012. But it has set off a huge culture clash with social conservatives, and at this point both the administration and the opponents would be happy to just get the issue resolved.

The political fight, of course, won’t go away that easily. If the mandate is struck down, it would be another huge political blow to the law, even though it wouldn’t prevent the rest of the law from functioning. If the justices uphold it, the administration will be able to say it has been vindicated yet again — but Republicans and religious conservatives won’t stop attacking it as a violation of employers’ religious beliefs.

Democrats, however, don’t think it’s going to work out well for Republicans to keep arguing against a benefit that has been so popular with women voters. “Anyone who’s on the side of a woman’s boss being able to decide what her birth control coverage is, I wouldn’t want to be on that side of the argument,” said Andrews.

Dealing with Congress

On Capitol Hill, the threat to the law isn’t so much another series of repeal or defunding votes. It’s the ongoing series of hearings Republicans will hold to keep any implementation problems front and center — and the constant danger of red state Democrats calling for their own rewrites to the law.

It’s not impossible that House Republicans will hold more votes to delay parts of the law and that they could draw large numbers of Democratic votes. That’s an especially strong possibility if Republicans try again to delay the individual mandate, since the administration has already had to delay so many other, smaller deadlines in the law as the implementation falls behind schedule.

But the main focus in the House will be the hearings, since Republicans are convinced their best shot at keeping repeal hopes alive is to highlight every problem that can be linked to the law.

“While there may be additional targeted legislative strikes, the heavy emphasis will be on oversight,” said Brendan Buck, a spokesman for House Speaker John Boehner. “The law can’t truly be ‘fixed,’ so we’ll be making the case for repeal by highlighting the endless negative consequences of the law.”

And in the Senate, Democrats in close reelection races — like Jeanne Shaheen of New Hampshire and Mary Landrieu of Louisiana — will keep up their public push for changes, all part of an effort to show they’re leaning on the White House to fix implementation problems.

The Obama administration has already shown that it’s going to take outreach to these Democrats more seriously — especially with the return of Phil Schiliro, who headed the push for the health care law. Schiliro has “deep, personal relationships with a significant number of members” and “knows the health law inside and out,” so he should be able to convince them the administration is working with them to smooth the law’s implementation, according to a senior Democratic aide.

That’s probably not going to be enough to keep the Shaheens and the Landrieus from pushing for legislative fixes, but they shouldn’t hold their breath for the Senate to vote on them. These Democrats may just get more space from the leadership to distance themselves in public from the implementation problems.

“They’re going to have to do what they have to do, but the caucus is in a different place right now” after the repairs to the website, said one Democratic strategist with ties to the Senate leadership.

The elections

This will be the first time Democrats have faced the voters when the main parts of the Affordable Care Act are in force — so it will be the most important referendum yet.

Will Democrats actually run on it? If it has enrolled enough people and seems to be working in a recently competent way, they might. But it’s no sure thing, especially if other fires break out during the fall, during the height of election season. That’s especially possible if some small businesses start facing premium hikes, which could hit in October, as they switch to health plans that comply with the law’s new pricing rules.

Democrats may be able to get off the defensive, but “I don’t think there’s going to be a whole lot of people running on it,” said Democratic pollster John Anzalone. The implementation is sure to improve and they’ll be freed up to talk about other issues, he said, but “I don’t think there’s going to be a ‘told you so’ moment for Democrats.”

But freshman Rep. Joe Garcia of Florida, one of the most endangered House incumbents in the country, insists he won’t be afraid to talk about it at all.

“As this rolls out, I run into more and more people who shake my hand, their eyes watering at what they’ve been able to accomplish” by signing up for health insurance, Garcia said late last month after he’d returned to his district for the holidays. “This may not be perfect, but nothing ever is.”

Garcia — who represents southern Florida, including the Keys — isn’t shy about bashing the sloppy website rollout: “First impressions are lasting ones, and the administration clearly ruined the first impression.” And he’s one of the House Democrats who votes for delays and legislative changes. He voted for the House Republican Keep Your Health Plan Act, for example, and has already supported a one-year delay in the individual mandate.

But he also insists that the goal of expanded health coverage is worth the effort, since one third of his constituents are uninsured.

“I’m in. I’m all in,” Garcia said. “If I get a few minutes to explain it to [a voter], I’ll tell you how you’ll be better off. If not, I didn’t expect to be buried in the Capitol anyway.”